|
PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
43251
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$189.26 |
| Max. Negotiated Rate |
$5,222.22 |
| Rate for Payer: Aetna Commercial |
$994.50
|
| Rate for Payer: Aetna Medicare |
$1,760.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$760.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,116.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,116.40
|
| Rate for Payer: BCBS Complete |
$972.53
|
| Rate for Payer: BCBS MAPPO |
$1,693.12
|
| Rate for Payer: BCBS Trust/PPO |
$812.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,693.12
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cofinity Commercial |
$1,006.20
|
| Rate for Payer: Cofinity Commercial |
$819.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,693.12
|
| Rate for Payer: Healthscope Commercial |
$1,053.00
|
| Rate for Payer: Mclaren Medicaid |
$926.14
|
| Rate for Payer: Mclaren Medicare |
$1,693.12
|
| Rate for Payer: Meridian Medicaid |
$972.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,777.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,947.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$994.50
|
| Rate for Payer: PACE Medicare |
$1,608.46
|
| Rate for Payer: PACE SWMI |
$1,693.12
|
| Rate for Payer: PHP Commercial |
$994.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,693.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$926.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,222.22
|
| Rate for Payer: Priority Health Medicare |
$1,693.12
|
| Rate for Payer: Priority Health Narrow Network |
$4,177.77
|
| Rate for Payer: Priority Health SBD |
$737.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,693.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,693.12
|
| Rate for Payer: UHC Exchange |
$189.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,743.91
|
| Rate for Payer: VA VA |
$1,693.12
|
|
|
PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 43251
|
| Hospital Charge Code |
43251
|
| Min. Negotiated Rate |
$123.11 |
| Max. Negotiated Rate |
$819.00 |
| Rate for Payer: Aetna Commercial |
$260.40
|
| Rate for Payer: BCBS Complete |
$129.27
|
| Rate for Payer: BCBS Trust/PPO |
$748.60
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Mclaren Medicaid |
$123.11
|
| Rate for Payer: Meridian Medicaid |
$129.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.08
|
| Rate for Payer: Priority Health Narrow Network |
$338.08
|
| Rate for Payer: Priority Health SBD |
$338.08
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
43239
|
| Min. Negotiated Rate |
$33.11 |
| Max. Negotiated Rate |
$575.40 |
| Rate for Payer: Aetna Commercial |
$183.36
|
| Rate for Payer: BCBS Complete |
$91.70
|
| Rate for Payer: BCBS Trust/PPO |
$33.11
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Mclaren Medicaid |
$87.33
|
| Rate for Payer: Meridian Medicaid |
$91.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.71
|
| Rate for Payer: Priority Health Narrow Network |
$238.71
|
| Rate for Payer: Priority Health SBD |
$238.71
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Facility
|
IP
|
$822.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
43239
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$517.86 |
| Max. Negotiated Rate |
$739.80 |
| Rate for Payer: Aetna Commercial |
$698.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.30
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cofinity Commercial |
$575.40
|
| Rate for Payer: Cofinity Commercial |
$706.92
|
| Rate for Payer: Healthscope Commercial |
$739.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$698.70
|
| Rate for Payer: PHP Commercial |
$698.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.40
|
| Rate for Payer: Priority Health SBD |
$517.86
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Facility
|
OP
|
$822.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
43239
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$134.25 |
| Max. Negotiated Rate |
$2,519.41 |
| Rate for Payer: Aetna Commercial |
$698.70
|
| Rate for Payer: Aetna Medicare |
$838.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,008.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,008.22
|
| Rate for Payer: BCBS Complete |
$463.30
|
| Rate for Payer: BCBS MAPPO |
$806.58
|
| Rate for Payer: BCBS Trust/PPO |
$386.40
|
| Rate for Payer: BCN Medicare Advantage |
$806.58
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cofinity Commercial |
$706.92
|
| Rate for Payer: Cofinity Commercial |
$575.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$806.58
|
| Rate for Payer: Healthscope Commercial |
$739.80
|
| Rate for Payer: Mclaren Medicaid |
$441.20
|
| Rate for Payer: Mclaren Medicare |
$806.58
|
| Rate for Payer: Meridian Medicaid |
$463.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$927.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$698.70
|
| Rate for Payer: PACE Medicare |
$766.25
|
| Rate for Payer: PACE SWMI |
$806.58
|
| Rate for Payer: PHP Commercial |
$698.70
|
| Rate for Payer: PHP Medicare Advantage |
$806.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$441.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,519.41
|
| Rate for Payer: Priority Health Medicare |
$806.58
|
| Rate for Payer: Priority Health Narrow Network |
$2,015.53
|
| Rate for Payer: Priority Health SBD |
$517.86
|
| Rate for Payer: Railroad Medicare Medicare |
$806.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$806.58
|
| Rate for Payer: UHC Exchange |
$134.25
|
| Rate for Payer: UHC Medicare Advantage |
$830.78
|
| Rate for Payer: VA VA |
$806.58
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
HCPCS 43239
|
| Min. Negotiated Rate |
$33.11 |
| Max. Negotiated Rate |
$575.40 |
| Rate for Payer: Aetna Commercial |
$183.36
|
| Rate for Payer: BCBS Complete |
$91.70
|
| Rate for Payer: BCBS Trust/PPO |
$33.11
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Mclaren Medicaid |
$87.33
|
| Rate for Payer: Meridian Medicaid |
$91.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.71
|
| Rate for Payer: Priority Health Narrow Network |
$238.71
|
| Rate for Payer: Priority Health SBD |
$238.71
|
|
|
PR EGD TRANSORAL CONTROL BLEEDING ANY METHOD
|
Professional
|
Both
|
$1,130.00
|
|
|
Service Code
|
HCPCS 43255
|
| Min. Negotiated Rate |
$125.67 |
| Max. Negotiated Rate |
$935.09 |
| Rate for Payer: Aetna Commercial |
$266.36
|
| Rate for Payer: BCBS Complete |
$131.95
|
| Rate for Payer: BCBS Trust/PPO |
$935.09
|
| Rate for Payer: Cash Price |
$904.00
|
| Rate for Payer: Cash Price |
$904.00
|
| Rate for Payer: Mclaren Medicaid |
$125.67
|
| Rate for Payer: Meridian Medicaid |
$131.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$345.14
|
| Rate for Payer: Priority Health Narrow Network |
$345.14
|
| Rate for Payer: Priority Health SBD |
$345.14
|
|
|
PR EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION
|
Professional
|
Both
|
$818.00
|
|
|
Service Code
|
HCPCS 43254
|
| Min. Negotiated Rate |
$169.34 |
| Max. Negotiated Rate |
$1,640.37 |
| Rate for Payer: Aetna Commercial |
$358.95
|
| Rate for Payer: BCBS Complete |
$177.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,640.37
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Mclaren Medicaid |
$169.34
|
| Rate for Payer: Meridian Medicaid |
$177.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$572.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$465.09
|
| Rate for Payer: Priority Health Narrow Network |
$465.09
|
| Rate for Payer: Priority Health SBD |
$465.09
|
|
|
PR EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 43240
|
| Min. Negotiated Rate |
$41.74 |
| Max. Negotiated Rate |
$815.50 |
| Rate for Payer: Aetna Commercial |
$521.19
|
| Rate for Payer: BCBS Complete |
$258.09
|
| Rate for Payer: BCBS Trust/PPO |
$41.74
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Mclaren Medicaid |
$245.80
|
| Rate for Payer: Meridian Medicaid |
$258.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$245.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$673.82
|
| Rate for Payer: Priority Health Narrow Network |
$673.82
|
| Rate for Payer: Priority Health SBD |
$673.82
|
|
|
PR EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER
|
Professional
|
Both
|
$788.00
|
|
|
Service Code
|
HCPCS 43253
|
| Min. Negotiated Rate |
$164.65 |
| Max. Negotiated Rate |
$1,676.30 |
| Rate for Payer: Aetna Commercial |
$348.83
|
| Rate for Payer: BCBS Complete |
$172.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,676.30
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Mclaren Medicaid |
$164.65
|
| Rate for Payer: Meridian Medicaid |
$172.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$452.74
|
| Rate for Payer: Priority Health Narrow Network |
$452.74
|
| Rate for Payer: Priority Health SBD |
$452.74
|
|
|
PR EKG FOR INITIAL PREVENT EXAM
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS G0403
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$1,763.47 |
| Rate for Payer: Aetna Commercial |
$19.23
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,763.47
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.33
|
| Rate for Payer: Priority Health Narrow Network |
$20.33
|
| Rate for Payer: Priority Health SBD |
$20.33
|
|
|
PR EKG INTERPRET & REPORT PREVE
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS G0405
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$1,397.35 |
| Rate for Payer: Aetna Commercial |
$11.04
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,397.35
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.34
|
| Rate for Payer: Priority Health Narrow Network |
$11.34
|
| Rate for Payer: Priority Health SBD |
$11.34
|
|
|
PR EKG TRACING FOR INITIAL PREV
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS G0404
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$2,970.10 |
| Rate for Payer: Aetna Commercial |
$8.19
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,970.10
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.99
|
| Rate for Payer: Priority Health Narrow Network |
$8.99
|
| Rate for Payer: Priority Health SBD |
$8.99
|
|
|
PR ELASTIC GARMENT/COVERING
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS A4466
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$11.90 |
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.90
|
|
|
PR ELEC ALYS IMPLT BRN NPGT PRGRMG 1ST 15 MIN
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 95983
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$205.51 |
| Rate for Payer: Aetna Commercial |
$55.41
|
| Rate for Payer: BCBS Complete |
$32.66
|
| Rate for Payer: BCBS Trust/PPO |
$205.51
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Mclaren Medicaid |
$31.10
|
| Rate for Payer: Meridian Medicaid |
$32.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.58
|
| Rate for Payer: Priority Health Narrow Network |
$65.58
|
| Rate for Payer: Priority Health SBD |
$65.58
|
|
|
PR ELEC ALYS IMPLT BRN NPGT PRGRMG EA ADDL 15 MIN
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 95984
|
| Min. Negotiated Rate |
$27.26 |
| Max. Negotiated Rate |
$269.43 |
| Rate for Payer: Aetna Commercial |
$48.95
|
| Rate for Payer: BCBS Complete |
$28.62
|
| Rate for Payer: BCBS Trust/PPO |
$269.43
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Mclaren Medicaid |
$27.26
|
| Rate for Payer: Meridian Medicaid |
$28.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.50
|
| Rate for Payer: Priority Health Narrow Network |
$57.50
|
| Rate for Payer: Priority Health SBD |
$57.50
|
|
|
PR ELEC ALYS IMPLT CPLX CN NPGT PRGRMG
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 95977
|
| Min. Negotiated Rate |
$32.59 |
| Max. Negotiated Rate |
$154.26 |
| Rate for Payer: Aetna Commercial |
$58.47
|
| Rate for Payer: BCBS Complete |
$34.22
|
| Rate for Payer: BCBS Trust/PPO |
$154.26
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Mclaren Medicaid |
$32.59
|
| Rate for Payer: Meridian Medicaid |
$34.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.17
|
| Rate for Payer: Priority Health Narrow Network |
$69.17
|
| Rate for Payer: Priority Health SBD |
$69.17
|
|
|
PR ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 95972
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$168.53 |
| Rate for Payer: Aetna Commercial |
$45.74
|
| Rate for Payer: Aetna Commercial |
$45.74
|
| Rate for Payer: BCBS Complete |
$26.62
|
| Rate for Payer: BCBS Complete |
$26.62
|
| Rate for Payer: BCBS Trust/PPO |
$168.53
|
| Rate for Payer: BCBS Trust/PPO |
$168.53
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Mclaren Medicaid |
$25.35
|
| Rate for Payer: Mclaren Medicaid |
$25.35
|
| Rate for Payer: Meridian Medicaid |
$26.62
|
| Rate for Payer: Meridian Medicaid |
$26.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.89
|
| Rate for Payer: Priority Health Narrow Network |
$53.89
|
| Rate for Payer: Priority Health Narrow Network |
$53.89
|
| Rate for Payer: Priority Health SBD |
$53.89
|
| Rate for Payer: Priority Health SBD |
$53.89
|
|
|
PR ELEC ALYS IMPLT NPGT PHYS/QHP W/O PROGRAMMING
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 95970
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$219.77 |
| Rate for Payer: Aetna Commercial |
$20.90
|
| Rate for Payer: BCBS Complete |
$12.08
|
| Rate for Payer: BCBS Trust/PPO |
$219.77
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Mclaren Medicaid |
$11.50
|
| Rate for Payer: Meridian Medicaid |
$12.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.71
|
| Rate for Payer: Priority Health Narrow Network |
$24.71
|
| Rate for Payer: Priority Health SBD |
$24.71
|
|
|
PR ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGRMG
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 95971
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$475.47 |
| Rate for Payer: Aetna Commercial |
$44.17
|
| Rate for Payer: BCBS Complete |
$25.72
|
| Rate for Payer: BCBS Trust/PPO |
$475.47
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Mclaren Medicaid |
$24.50
|
| Rate for Payer: Meridian Medicaid |
$25.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.65
|
| Rate for Payer: Priority Health Narrow Network |
$51.65
|
| Rate for Payer: Priority Health SBD |
$51.65
|
|
|
PR ELEC ALYS IMPLT SMPL CN NPGT PRGRMG
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 95976
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$140.93 |
| Rate for Payer: Aetna Commercial |
$43.64
|
| Rate for Payer: BCBS Complete |
$25.72
|
| Rate for Payer: BCBS Trust/PPO |
$140.93
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Mclaren Medicaid |
$24.50
|
| Rate for Payer: Meridian Medicaid |
$25.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.65
|
| Rate for Payer: Priority Health Narrow Network |
$51.65
|
| Rate for Payer: Priority Health SBD |
$51.65
|
|
|
PR ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV 1ST HR
|
Professional
|
Both
|
$940.00
|
|
|
Service Code
|
HCPCS 95974
|
| Min. Negotiated Rate |
$376.00 |
| Max. Negotiated Rate |
$658.00 |
| Rate for Payer: BCBS Complete |
$376.00
|
| Rate for Payer: Cash Price |
$752.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$658.00
|
|
|
PR ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH EA 30 MIN
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 95973
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$115.50 |
| Rate for Payer: BCBS Complete |
$66.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
|
|
PR ELEC STIM OTHER THAN WOUND
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS G0283
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$367.70 |
| Rate for Payer: Aetna Commercial |
$9.50
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$367.70
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.99
|
| Rate for Payer: Priority Health Narrow Network |
$11.99
|
| Rate for Payer: Priority Health SBD |
$11.99
|
|
|
PR ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
HCPCS 62368
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$144.20 |
| Rate for Payer: Aetna Commercial |
$45.55
|
| Rate for Payer: BCBS Complete |
$22.82
|
| Rate for Payer: BCBS Trust/PPO |
$45.43
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Mclaren Medicaid |
$21.73
|
| Rate for Payer: Meridian Medicaid |
$22.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.75
|
| Rate for Payer: Priority Health Narrow Network |
$57.75
|
| Rate for Payer: Priority Health SBD |
$57.75
|
|
